tbuckley/cabot-search huggingface dataset:
Clinical Case 31—Active gastrointestinal bleeding during STEMI: a management dilemma
Authors: Vanessa Filipa de Sousa Lopes, Nádia Moreira, Francisco Gonçalves, Lino Gonçalves
Journal: Cardiovascular Research (2022)

Abstract A man in his 40s presented to the emergency department with chest pain for 8 hours. ECG showed an anterior wall ST-segment elevation myocardial infarction (MI). He received a loading dose of both aspirin and ticagrelor. Coronary angiography demonstrated occlusion of the proximal left anterior descending artery, and primary percutaneous coronary intervention (PCI) with one drug-eluting stent was performed. The patient also presented melena for 5 days. At admission, his hemoglobin was 6.3 g/dL and he was stable. He received a blood transfusion and was started on IV pantoprazole. Endoscopic study was postponed due to concerns related to performing such exam in the setting of a recent MI. The day after PCI, the patient presented major bleeding and hypotension, leading to interruption of the P2Y12 inhibitor. On day 3 of hospitalization, while on single antiplatelet therapy with aspirin, the patient presented new onset of chest pain. He was diagnosed with subacute stent thrombosis (type 4b MI), and thrombus aspiration and balloon angioplasty were performed (Figure 1A, and B). Dual antiplatelet therapy was immediately restarted. Echocardiography revealed worsened left ventricular disfunction (LVEF of 20%). Endoscopy showed tears in the esophagogastric junction (Mallory-Weiss syndrome). This case challenged clinical decision-making, especially the antithrombotic strategy after primary PCI in a patient with major bleeding. Learning points Management of a bleeding patient with acute MI should be individualized. The decision to withhold antithrombotic treatment should weigh the risks related to ongoing bleeding and stent thrombosis. Early endoscopy for acute gastrointestinal bleed in recent MI appears to be a safe procedure for hemorrhage control, although evidence is lacking. Figure 1 Coronary angiography. A—Total occlusion with in-stent thrombus in the proximal left anterior descending artery. B—After thrombus aspiration and angioplasty with paclitaxel-coated balloon of stent thrombosis in the proximal left anterior descending artery, remaining a residual lesion of 50–70%, and distal flow TIMI grade 3.
Srsf2P95H/+ co-operates with loss of TET2 to promote myeloid bias and initiate a chronic myelomonocytic leukemia-like disease in mice
Authors: Jane Jialu Xu, Alistair M. Chalk, Meaghan Wall, Wallace Y. Langdon, Monique F. Smeets, Carl R. Walkley
Journal: Leukemia (2022)
Oral Presentation No. 105 Endothelial dysfunction and alterations in erythrocyte function in a murine model of chronic heart failure
Authors: Tasnim Mohaissen
Journal: Cardiovascular Research (2022)

Abstract Endothelial dysfunction (ED) and red blood cell distribution width (RDW) are both prognostic factors in heart failure (HF), but the relationship between them is not clear. In this study, we used a unique mouse model of HF to characterize the relationship between the development of peripheral ED and the occurrence of structural nanomechanical and biochemical changes in red blood cells (RBCs). Methods and results Systemic ED was detected in vivo in 8-month-old Tgαq*44 mice, as evidenced by impaired acetylcholine-induced vasodilation in the aorta. ED in the aorta was associated with impaired nitric oxide (NO) production in the aorta and diminished systemic NO bioavailability (characterized by increased superoxide and eicosanoid production). In 4- to 6-month-old Tgαq*44 mice, RBC size and membrane composition displayed alterations that did't result in significant changes in their nanomechanical and functional properties. However, 8-month- old Tgαq*44 mice presented accentuated structural, size changes and increased RBC stiffness. In 12-month-old Tgαq*44 mice, the erythropathy was featured by altered RBC shape and elasticity, increased RDW, impaired RBC deformability. Moreover, RBCs taken from 12-month-old Tgαq*44 mice, coincubated with aortic rings from FVB mice, induced impaired endothelium-dependent vasodilation and this effect was partially reversed by arginase inhibitor. Conclusion In the Tgαq*44 murine model of HF, systemic ED accelerates erythropathy and, conversely, erythropathy may contribute to ED. These results suggest that erythropathy may be regarded as a marker and a mediator of systemic ED in HF. RBC arginase and possibly other RBC-mediated mechanisms may represent novel therapeutic targets for systemic ED in HF.
Poster No. 111 Therapeutic Options and Outcomes in Mid Aortic Syndrome A systematic review and meta-analysis
Authors: Roland R J Van Kimmenade, Kimberley Cortenbach, Bahram Yosofi, Laura Rodwell, Jelena Meek, Ritesh Patel, Siddharth Prakash, Niels Riksen, Sjoerd Jenniskens, Mark Dirven, Marco de Ruiten
Journal: Cardiovascular Research (2022)

Abstract Objective Mid-Aortic Syndrome (MAS) is narrowing of the distal thoracic and/or abdominal aorta with congenital, inflammatory or idiopathic aetiology. If untreated, prognosis is poor due to hypertensive complications yet follow-up data are sparse. The aim of this study was to investigate hypertension during follow-up after medical, endovascular, and surgical therapy. Design and methods A meta-analysis of case series and reports, focusing on the incidence of hypertension during the follow-up of juvenile (0–17 years) and adult MAS patients after medical, endovascular or surgical therapy. Search queries were performed in PubMed, Embase, and Web of Science; eligible articles underwent quality control. Descriptive statistics were reported based on available data, individual patient data meta-analyses were performed using a one-stage approach, accounting for clustering by case series or decades of reporting for case reports. For the meta-analysis, missing outcome and aetiology data were multiply imputed. Results The number of juveniles and adults who underwent endovascular therapy (33.7% versus 27.3%; P = .42) and surgery (52.2% versus 58.0%; P = .46) was similar. At baseline, 92.4% of juveniles and 87.5% of adults were hypertensive, decreasing to 23.2% and 24.1% during a follow-up of 23 (juveniles) and 18 (adults) months. In juveniles, after endovascular therapy more hypertension was found compared to surgery (38.1% versus 10.8%; P = .020). Meta-analysis demonstrated a trend for hypertension after endovascular therapy in juveniles, whereas hypertension was more prevalent following surgery in adults compared to endovascular therapy or medication. Conclusions Complications and hypertension in MAS during follow-up were more common in juveniles after endovascular treatment, whereas surgery in adults was associated with more hypertension.
Poster No. 012 Premature myocardial infarction: a decade-long analysis of patients admitted to a single-center coronary care unit
Authors: Vanessa Lopes, Nádia Moreira, Rafaela Fernandes, Gil Cunha, Gonçalo Costa, Eric Monteiro, Diogo Fernandes, Joana Guimarães, João Ferreira, James Milner, Vera Marinho, Sílvia Monteiro, Pedro Monteiro, Francisco Gonçalves, Lino Gonçalves
Journal: Cardiovascular Research (2022)

Abstract Background Despite being primarily a disease of older patients, acute myocardial infarction (AMI) has been increasingly recognized in young individuals. This study sought to characterize and determine the prognosis of AMI in patients aged ≤ 45 years old. Methods We retrospectively analyzed patients consecutively admitted to the coronary care unit with AMI. Two groups were identified: patients aged ≤ 45 and &amp;gt; 45 years old. Results and conclusions A total of 5696 AMI patients were included in the analysis: median age of 70 (IQR 19) years and 68.6% (n = 3906) were male; 5.6% (n = 318) of patients were aged ≤ 45 years old. In contrast to the older patients, those aged ≤ 45 years old were more likely to be male (P &amp;lt; 0.001), presented more often with a history of smoking (P &amp;lt; 0.001), and family history of premature coronary artery disease (P &amp;lt; 0.001), but less often hypertension, hyperlipidemia, and diabetes. In coronary angiography, most younger patients presented a single-vessel disease (57.1%), more commonly affecting the left anterior descending artery (51.7%); left main involvement was rare (0.8%); and 14.2% presented MINOCA (vs. 11.4% of older patients). Regarding prognosis, 6.4% (n = 366) of patients died in the hospital and 24.2% (n = 1380) died during the 5-year follow-up. Younger patients had a lower risk of in-hospital mortality (OR 0.22, 95% CI 0.09–541, P = 0.001) and 5-year mortality (OR 0.12, 95% CI 0.06–0.201, P &amp;lt; 0.001), compared to the older patients. In conclusion, patients with premature AMI have a different proportion of risk factors, less extensive coronary artery disease, and more commonly present MINOCA, compared to the older patients.
Oral Presentation No. 81 A STEMI case with sub-occlusive lesion and high thrombotic burden – discussing a tailored approach
Authors: Maria Rita Lima, Luís Raposo, Francisco Albuquerque, Afonso Félix Oliveira, Manuel Almeida, João Abecasis, Miguel Mendes
Journal: Cardiovascular Research (2022)

Abstract A 57-year-old man was admitted with an anterior wall STEMI. The patient had a past medical history of pulmonary thromboembolism after an abdominal surgery and peripheral artery disease. After receiving loading doses of aspirin and unfractionated heparin, the patient underwent emergent coronary angiography (CA), that revealed a high thrombotic sub-occlusive lesion in the middle left anterior descending artery (mLAD), with TIMI 3 flow. At the time of CA, the ST elevation had disappeared, and the patient was asymptomatic. PCI had the risk of distal embolization and wiring of the false lumen if a dissection was present. Given the patient stability and absence of pain, the team decided to optimize anti-thrombotic therapy - aspirin + ticagrelor + enoxaparin - and repeat the CA within 72–96 h. The patient remained asymptomatic without angina or heart failure. Repeated CA showed a significant reduction of thrombus in the mLAD, maintaining TIMI 3 flow. A non-obstructive lesion was noted, being unclear if there was plaque rupture or localized dissection. Coronary CT angiography (CCTA) showed a coronary calcium score of 0 and an endoluminal flap in the mLAD, with a partial non-obstructive thrombosis. Echocardiography showed preserved LVEF without segmental abnormalities. Given the good results of anti-thrombotic therapy, the patient was discharged with aspirin, clopidogrel and rivaroxaban 2.5 mg 2id for 2 months and PCI was not performed. A follow-up CCTA within 2 months was scheduled. This case illustrates a complex STEMI case with a high thrombotic burden. The best strategy in such cases is open to debate.
Clinical Case 08—A challenging clinical case: acute limb ischemia as a presentation of a left ventricular thrombus in a patient with heart failure with reduced ejection fraction
Authors: Daniel Eduardo Paz Driotes, Veronica Vanesa Gomez Leiva
Journal: Cardiovascular Research (2022)

Abstract A 57-year-old male with arterial hypertension, diabetes mellitus, ischemic heart disease and coronary bypass in 2018, was admitted to the hospital with a 1-day evolution of sudden pain of strong intensity in the lower right limb. On physical examination, lower right limb showed erythrocyanosis, multiple distal ulcers, absence of hair, distal coldness up to the level of the knee, capillary refill &amp;gt;5 seconds, with absence of pedal and popliteal pulses. Arterial echo-Doppler of the lower right limb was performed, which reported common femoral and superficial femoral arterial insufficiency, with no flow in the distal third of the femoral, popliteal, tibial, and peroneal arteries. AngioCT of the lower limbs reported bilateral chronic arterial insufficiency with no flow from the superficial femoral artery to the popliteal and anterior tibial arteries of the right leg. A transthoracic echocardiogram was performed, which reported dilated heart disease with a left ventricular ejection fraction of 16% and an apical thrombus in the left ventricle of approximately 1.2 cm × 4.1 cm. Anticoagulation with unfractionated heparin was started, and thrombectomy of the lower right limb was evaluated, with a high probability of amputation due to irreversibility of ischemia. However, due to a high probability of surgical complications, conservative management was decided. Due to Virchow’s triad, patients with ischemic heart disease and heart failure with reduced ejection fraction are at high risk of intraventricular thrombi and subsequent embolization; therefore, the use of prophylactic anticoagulation should be considered to prevent this type of complication despite the evidence is controversial. Figure 1A. 3D reconstruction of AngioCT of the lower limbs, arterial phase, red arrow indicates occluded flow in the form of a pencil point in the proximal third of the right superficial femoral artery, suggesting arterial thombosis. B and C. 4C EchoTT with an image of a large, consolidated thrombus with well-defined edges in the apex attached to the wall running over the interventricular septum (green arrow).
Oral Presentation No. 67 Thrombotic Events in COVID-19 Patients Admitted at Chinese General Hospital and Medical Center
Authors: Joel Santos, Jenny Beltran
Journal: Cardiovascular Research (2022)

Abstract Background Thrombosis is among the most prominent and concerning complications associated with COVID-19. These thrombotic events have been associated in progression of ARDS and morbidity and mortality. Methodology Retrospective cohort study of 203 patients ≥ 18 years old with confirmed COVID-19 admitted on tertiary referal hospital from January to December 2021. All thrombotic events were established by clinical signs and symptoms, ultrasonography and CT scan. Results and conclusions Sixty five (32%) patients out of 203 developed thrombotic complications. The most common thrombotic event was pulmonary embolism (36%), followed by myocardial infarction (28%), cerebrovascular infarct (27%), DVT (25%), acute limb ischemia (7%) and lastly, mesenteric ischemia (6%). There were significant differences in demographic and clinical profile among COVID-19 patients with and without thrombotic events. Thrombosis was more commonly seen in advanced age (≥ 75 years, 49.2% vs. 23.9%; RR2.06, CI1.4–3.03), severe infection (severe, 24.6% vs. 19.6%; RR1.2, CI0.8–1.9 and critical and 47.7% vs. 10.1%; RR3.2, CI2.2–4.6, respectively), ICU admission (20% vs. 3.6%; RR2.6, CI1.8–3.7). Other complications were acute respiratory syndrome (83% vs. 43.5%; RR3.8, CI2.1–6.9), acute kidney injury (50.8% vs. 19.6%; RR2.46, CI1.68–3.6), major bleeding (9.2% vs. 0%; RR2.07, CI1.83–2.34), clinically relevant non-major bleeding (30.8% vs. 10.1%; RR2.21, CI1.52–3.22), hospitalization &amp;gt; 21 days (29.2% vs. 13%; RR1.85, CI1.24–2,76), and all-cause mortality (60% vs. 3.6%; RR5.42, CI3.76–7.82). Patients who developed thrombosis had prolonged duration of immobilization, higher Padua prediction and CURB 65 scores, with wall motion abnormality in 2D-echocardiography, elevated D-dimer and pro-BNP, reduced oxygen saturation an often received invasive and non-invasive ventilation and hemoperfusion. Majority of patients was given thromboprophylaxis in both groups; hence a significant difference was not found. An institutional thromboprophylaxis protocol is needed in managing COVID-19 patients at risk for thrombotic events.
Clinical Case 16—Intracoronary thrombus- a fatality to unmask
Authors: Isabel Martins da Cruz, Inês Oliveira, Bruno Bragança, Rafaela Lopes, Inês Campos, Rui Santos, Aurora Andrade
Journal: Cardiovascular Research (2022)

Abstract 26-years-old man, occasional cannabis smoker, attended the emergency department due to chest pain and epigastralgia for the past 24h, after cannabis consumption. Electrocardiogram revealed ST-segment elevation with Q-waves in V3-V5 and inferior leads. Transthoracic echocardiogram presented: (1) cardiac chamber dilation; (2) severely reduced biventricular systolic function; (3) hypokinesia of left ventricle basal segments of the anterior, lateral and septal walls; (4) scar appearance of the posterior wall and ventricular apex; (5) apical thrombus. Emergent cardiac catheterization showed thrombus located at the medial and distal segments of the left anterior descending artery (LAD), occlusion of the first obtuse marginal (OM) artery and thrombus at the medial and distal segments of the right coronary artery. Angioplasty of the OM was unsuccessful and hypocoagulation was initiated. The patient started veno-arterial ECMO. Immunological study was normal. His clinical condition deteriorated with multiple organ dysfunction, and he died after 20 days. The autopsy revealed coronary atherosclerosis with fibrous plaques causing 80% stenosis of the LAD with two sub-occlusive thrombus, occlusion of the circumflex artery, 70% stenosis of the posterior descending artery, two areas of myocardial infarction and several intracardiac thrombus. We aim to discuss the possible aetiologies for the thrombus formation. The association between cannabis and acute coronary syndromes has been reported and in cases of young adults with chest pain this diagnosis should be considered. Alternatively, our patient presented dilated cardiac chambers with scar walls and presence of intracardiac thrombus that could be the cause of systemic embolization in an undiagnosed dilated cardiomyopathy.
Clinical Case 09—Acute pulmonary embolism complicated by acute limb ischemia: a case report on the role of patent foramen ovale closure in thrombophilia
Authors: David Sá Couto, André Alexandre, António Marinho, Filomena Oliveira, André Luz, Severo Torres
Journal: Cardiovascular Research (2022)

Abstract Case report A 40-year-old obese man with hypertension and history of femoro-popliteal deep vein thrombosis (DVT), presented to the emergency department with right lower limb (RLL) ischemia associated with exertional dyspnoea for the past three weeks. Physical examination revealed a cold RLL without peripheral pulses and mild respiratory failure. Angio-CT revealed bilateral acute pulmonary embolism (APE), thrombosis of the right common iliac artery and left renal infarct (Figure 1A). Transthoracic echocardiogram revealed signs of pulmonary hypertension (PH), dilated right ventricle and a suspected patent foramen ovale (PFO) with spontaneous high volume right-to-left shunt. A diagnosis of intermediate-low risk APE with concomitant RLL acute ischemia was made. The patient underwent iliac thrombectomy, local fibrinolysis and started anticoagulation. Immunological study was positive for antiphospholipid syndrome. He recovered well and was discharged on Vitamin-K antagonists. Six months later, transoesophageal echocardiogram confirmed the PFO with persistence of right-to-left shunt with a bubble test, and recovery of the right ventricle function without signs of PH (Figure 1B). Due to the suspected paradoxical embolic event, resolution of the PH and shunt persistence, the patient underwent percutaneous PFO closure with Amplatzer PFO Occluder (25mm) [Abbott®] (Figure 1C). He has had no recurrence of thrombotic events ever since. Conclusion Concomitant arterial and venous thrombosis should prompt screening for an intracardiac shunt. Despite unclear evidence, PFO closure might reduce the risk for paradoxical embolism recurrence in a thrombophilic setting on top of oral anticoagulation.
Poster No. 110 History of venous thromboembolic disease: a prognostic risk marker following STEMI? Insights of the French SCALIM registry
Authors: Pierre Chenard, Benjamin Dousset, Marouane Boukhris, Patrice Virot, Victor Aboyans
Journal: Cardiovascular Research (2022)

Abstract Background Venous and arterial thrombosis are two different entities. However, they share common risk factors and a continuum between arterial and venous thrombosis has been suggested. The purpose of our study was to determine whether a history venous thromboembolic disease (VTE) is associated with poorer outcome in patients with ST-elevation myocardial infarction (STEMI). Methods All consecutive STEMI patients between 2011 and 2019 were included in our regional SCALIM registry. Clinical history of VTE was collected at baseline. The primary outcome was cardiovascular mortality and recurrent non-fatal arterial events (including non-fatal-myocardial infarction, ischemic stroke and peripheral ischemic event) at 5-year follow-up. The secondary outcome was total mortality. Results A total of 1924 patients (64.7 ± 14.1 years; 75.1% men) were included, among whom 2.8% with history of VTE. The latter were older than those without VTE (respectively 72.8 ± 14.1 vs. 64.4 ± 14.0 years; P &amp;lt; 0.001) and had more often hypertension, history of stroke and cancer. We found no statistical difference between the two groups regarding the 5-year cardiovascular mortality (11.3% vs. 7.1%, P = 0.231) and recurrent non-fatal arterial events (17.0% vs. 14.9%, P = 0.754). Five-year all-cause mortality was significantly higher in patients with history of VTE (33.3% vs. 14.6%, P = 0.001). In a nested case-control study adjusted for age, no difference was found in primary and secondary outcomes according to VTE history. Conclusion We found no impact of history of VTE on 5-year cardiovascular outcome in who had STEMI patients. Higher mortality in these patients are related to older age and comorbidities.
Poster No. 103 Spontaneous coronary artery dissection: when pain and ST-segment elevation persist
Authors: Rafaela G Lopes, Isabel Cruz, Inês Pereira Oliveira, Bruno Bragança, Inês G Campos, Joel Ponte Monteiro, Carla Almeida, Alexandra Castro, Aurora Andrade
Journal: Cardiovascular Research (2022)

Abstract A 44-year-old female with nonrelevant medical history was admitted due to chest pain. She was hemodynamically stable. Normal physical examination. ECG with ST-segment depression in the inferior leads. Echocardiogram had no contractility abnormalities. High-sensitivity troponin I (hsTnI) of 164.4 pg/mL. Non-ST-segment elevation myocardial infarction (NSTEMI) diagnosis was made. 12 hours later she developed refractory chest pain. Emergent coronariography depicted independent ostia for the anterior descending and circumflex arteries and type 1 spontaneous coronary artery dissection (SCAD) of the circumflex artery. During angiography, pain subsided and a conservative approach was adopted. An hour later, she had recurrent pain refractory to medical treatment and new onset of persistent ST-segment elevation in leads V4-V6. It was decided to perform percutaneous coronary intervention and a drug eluting stent was placed in the proximal circumflex artery. There was distal propagation of the parietal hematoma, but TIMI 3 flow was restored. She was discharged on day 6. 5 days later she was readmitted due to NSTEMI. She had recurrent episodes of chest pain followed by reelevation of hsTnI. Coronary computer tomography depicted distal progression of the dissection with involvement of a first obtuse marginal and distal circumflex. After uptitration of anti-ischemic medication she was discharged. The case underlines the challenging and non-linear approach of SCAD in the setting persistent chest pain. Besides the technical difficulties of angioplasty, with higher risk of restenosis and stent failure, most recommendations support a conservative approach. However, persistent chest pain imply further action, as exemplified in this case report.